Influence of surface modifications on the degradation of standard-sized magnesium plates and healing of mandibular osteotomies in miniature pigs.

Biodegradable magnesium alloys are suitable osteosynthesis materials. Despite the alloy composition, surface modifications appear to have an influence on the degradation process and biocompatibility. The aim of this study was to investigate the impact of hydrogenation and fluoridation of the surface in a mandibular osteotomy model. Standard-sized plates and screws were implanted in an osteotomy at the mandibular angle in nine miniature pigs. The plates and screws were harvested together with the adjacent tissues at 8 weeks after surgery and were investigated by micro-computed tomography and histological analysis. The bone healing of the osteotomy was undisturbed, independent of the surface properties. The adjacent bone tissue showed new bone formation at the implant surface; however, formation of some lacunae could be observed. The corrosion was between 9.8% and 11.6% (fluoridated

Relative fibular strength and locomotor behavior in KNM-WT 15000 and OH 35.

Relative fibular/tibial strength has been demonstrated to vary with locomotor behavior among anthropoid primates. In this study fibular/tibial strength was determined in KNM-WT 15000, a juvenile Homo erectus individual (1.5 Ma), and in OH 35, a Homo habilis (or possibly Paranthropus boisei) individual (1.8 Ma), and compared to that of adult modern humans (n = 79), chimpanzees (n = 16), gorillas (n = 16) and orangutans (n = 11). Ontogenetic changes in fibular/tibial strength were also analyzed due to KNM-WT 15000's juvenile status. Cross-sectional properties at midshaft were derived from multi-plane radiography and external contours, or CT scanning. Comparisons of log-transformed fibular/tibial polar second moment of area and anteroposterior (A-P) and mediolateral (M-L) second moments of area were carried out between extant species. Fossil deviations from each extant taxon's mean proportion were calculated in standard deviation (SD) units for that taxon. Great apes differ significantly from modern humans, with relatively stronger fibulae, particularly in the M-L plane. KNM-WT 15000 is more than 2 SD from all great apes (≥3 SD in the M-L plane) and within 1 SD of modern humans for almost all variables. This is not a result of its age, as fibular/tibial strength slightly decreases with age (i.e., becomes less like that of great apes) in humans. OH 35 falls within 1 SD of chimpanzees and orangutans for the majority of cross-sectional proportions, but more than 1 SD from humans. KNM-WT 15000 is demonstrated to be fully modern, complimenting other indications of complete terrestrial bipedality and possibly showing adaptations for endurance running. OH 35 has some human-like features; however, the relative strength of the two bones aligns the specimen with great apes, consistent with a significant degree of arboreality, in particular, vertical climbing.

Mechanical determinants of bone form: insights from skeletal remains.

Analysis of skeletal remains from humans living in the past forms an important complement to observational and experimental studies of living humans and animal models. Including earlier humans in such analyses increases the range of variation in both behavior and body size and shape that are represented, and can provide insights into the adaptive potential of the modern human skeleton. I review here a variety of studies of archaeological and paleontological remains that have investigated differences in skeletal structure from a mechanical perspective, focusing in particular on diaphyseal strength of the limb bones. Several conclusions can be drawn from these studies: 1) there has been a decline in overall skeletal strength relative to body size over the course of human evolution that has become progressively steeper in recent millennia, probably due to increased sedentism and technological advancement; 2) differences in pelvic structure and hip mechanical loadings affect femoral shape; 3) activity patterns affect overall strength and shape of both the lower and upper limb bones; and 4) responsiveness to changes in mechanical loading varies between skeletal features (e.g., articulations versus diaphyses) and by age.

Relative variation in human proximal and distal limb segment lengths.

The pattern of variation and covariation of proximal and distal limb segment lengths was examined within and between 20 geographically diverse skeletal samples of modern humans. Analyses of variance-covariance matrices (VCMs) of logarithmically transformed (ln) variates of humerus, radius, femur, and tibia length were performed to test the following hypotheses: first, within populations, the distal and proximal segments will have equal relative (i.e., size-independent) variability. However, between populations, the tibia is predicted to be more variable than the other segments. Tests of fit of computed VCMs to theoretical matrices by an iterative procedure (Anderson [1973] Ann. Stat. 1:135-141) reject the equal variance hypotheses, rather suggesting that the relative variances of the distal limb segments are greater than are those of the proximal. Males and females differ somewhat in that within females, the distal segments of both limbs have equal variance, while within males, the tibia has greater relative variance than the radius. The second hypothesis, regarding between-group variability, is somewhat supported in that between human populations, one cannot reject that the tibia has greater relative variance than the other limb segments. However, neither can one reject an alternative hypothesis that both distal limb segments (tibia and radius) are more variable than the proximal segments. Differential growth allometry is explored, and likely plays a major role in differences seen both within and between human populations.

Structural adaptation to changing skeletal load in the progression toward hip fragility: the study of osteoporotic fractures.

Longitudinal, dual-energy X-ray absorptiometry (DXA) hip data from 4187 mostly white, elderly women from the Study of Osteoporotic Fractures were studied with a structural analysis program. Cross-sectional geometry and bone mineral density (BMD) were measured in narrow regions across the femoral neck and proximal shaft We hypothesized that altered skeletal load should stimulate adaptive increases or decreases in the section modulus (bending strength index) and that dimensional details would provide insight into hip fragility. Weight change in the approximately 35 years between scan time points was used as the primary indicator of altered skeletal load. "Static" weight was defined as within 5% of baseline weight, whereas "gain" and 'loss" were those who gained or lost >5%, respectively. In addition, we used a frailty index to better identify those subjects undergoing changing in skeletal loading. Subjects were classified as frail if unable to rise from a chair five times without using arm support. Subjects who were both frail and lost weight (reduced loading) were compared with those who were not frail and either maintained weight (unchanged loading) or gained weight (increased loading). Sixty percent of subjects (n = 2,559) with unchanged loads lost BMD at the neck but not at the shaft, while section moduli increased slightly at both regions. Subjects with increasing load (n = 580) lost neck BMD but gained shaft BMD; section moduli increased markedly at both locations. Those with declining skeletal loads (n = 105) showed the greatest loss of BMD at both neck and shaft; loss at the neck was caused by both increased loss of bone mass and greater subperiosteal expansion; loss in shaft BMD decline was only caused by greater loss of bone mass. This group also showed significant declines in section modulus at both sites. These results support the contention that mechanical homeostasis in the hip is evident in section moduli but not in bone mass or density. The adaptive response to declining skeletal loads, with greater rates of subperiosteal expansion and cortical thinning, may increase fragility beyond that expected from the reduction in section modulus or bone mass alone.

Body mass prediction from skeletal frame size in elite athletes.

Body mass can be estimated from measures of skeletal frame size (stature and bi-iliac (maximum pelvic) breadth) fairly accurately in modern human populations. However, it is not clear whether such a technique will lead to systematic biases in body mass estimation when applied to earlier hominins. Here the stature/bi-iliac method is tested, using data available for modern Olympic and Olympic-caliber athletes, with the rationale that these individuals may be more representative of the general physique and degree of physical conditioning characteristic of earlier populations. The average percent prediction error of body mass among both male and female athletes is less than 3%, with males slightly underestimated and females slightly overestimated. Among males, the ratio of shoulder to hip (biacromial/bi-iliac) breadth is correlated with prediction error, while lower limb/trunk length has only a weak inconsistent effect. In both sexes, athletes in "weight" events (e.g. , shot put, weight-lifting), which emphasize strength, are underestimated, while those in more endurance-related events (e.g., long distance running) are overestimated. It is likely that the environmental pressures facing earlier hominins would have favored more generalized physiques adapted for a combination of strength, speed, agility, and endurance. The events most closely approximating these requirements in Olympic athletes are the decathlon, pentathlon, and wrestling, all of which have average percent prediction errors of body mass of 5% or less. Thus, "morphometric" estimation of body mass from skeletal frame size appears to work reasonably well in both "normal" and highly athletic modern humans, increasing confidence that the technique will also be applicable to earlier hominins.

Structural trends in the aging femoral neck and proximal shaft: analysis of the Third National Health and Nutrition Examination Survey dual-energy X-ray absorptiometry data.

Hip scans of U.S. adults aged 20-99 years acquired in the Third National Health and Nutrition Examination Survey (NHANES III) using dual-energy X-ray absorptiometry (DXA) were analyzed with a structural analysis program. The program analyzes narrow (3 mm wide) regions at specific locations across the proximal femur to measure bone mineral density (BMD) as well as cross-sectional areas (CSAs), cross-sectional moments of inertia (CSMI), section moduli, subperiosteal widths, and estimated mean cortical thickness. Measurements are reported here on a non-Hispanic white subgroup of 2,719 men and 2,904 women for a cortical region across the proximal shaft 2 cm distal to the lesser trochanter and a mixed cortical/trabecular region across the narrowest point of the femoral neck. Apparent age trends in BMD and section modulus were studied for both regions by sex after correction for body weight. The BMD decline with age in the narrow neck was similar to that seen in the Hologic neck region; BMD in the shaft also declined, although at a slower rate. A different pattern was seen for section modulus; furthermore, this pattern depended on sex. Specifically, the section modulus at both the narrow neck and the shaft regions remains nearly constant until the fifth decade in females and then declined at a slower rate than BMD. In males, the narrow neck section modulus declined modestly until the fifth decade and then remained nearly constant whereas the shaft section modulus was static until the fifth decade and then increased steadily. The apparent mechanism for the discord between BMD and section modulus is a linear expansion in subperiosteal diameter in both sexes and in both regions, which tends to mechanically offset net loss of medullary bone mass. These results suggest that aging loss of bone mass in the hip does not necessarily mean reduced mechanical strength. Femoral neck section moduli in the elderly are on the average within 14% of young values in females and within 6% in males.

Stress fracture in military recruits: gender differences in muscle and bone susceptibility factors.

A total of 693 female U.S. Marine Corps recruits were studied with anthropometry and dual-energy X-ray absorptiometry (DXA) scans of the midthigh and distal third of the lower leg prior to a 12 week physical training program. In this group, 37 incident stress fracture cases were radiologically confirmed. Female data were compared with male data from an earlier study of 626 Marine recruits extended with additional cases for a total of 38 stress fracture cases. Using DXA data, bone structural geometry and cortical dimensions were derived at scan locations and muscle cross-sectional area was computed at the midthigh. Measurements were compared within gender between pooled fracture cases and controls after excluding subjects diagnosed with shin splints. In both genders, fracture cases were less physically fit, and had smaller thigh muscles compared with controls. After correction for height and weight, section moduli (Z) and bone strength indices (Z/bone length) of the femur and tibia were significantly smaller in fracture cases of both genders, but patterns differed. Female cases had thinner cortices and lower areal bone mineral density (BMD), whereas male cases had externally narrower bones but similar cortical thicknesses and areal BMDs compared with controls. In both genders, differences in fitness, muscle, and bone parameters suggest poor skeletal adaptation in fracture cases due to inadequate physical conditioning prior to training. To determine whether bone and muscle strength parameters differed between genders, all data were pooled and adjusted for height and weight. In both the tibia and femur, men had significantly larger section moduli and bone strength indices than women, although women had higher tibia but lower femur areal BMDs. Female bones, on average, were narrower and had thinner cortices (not significant in the femur, p = 0.07). Unlike the bone geometry differences, thigh muscle cross-sectional areas were virtually identical to those of the men, suggesting that the muscles of the women were not relatively weaker.

Body size, body shape, and long bone strength in modern humans.

To identify behaviorally significant differences in bone structure it is first necessary to control for the effects of body size and body shape. Here the scaling of cross-sectional geometric properties of long bone diaphyses with different "size" measures (bone length, body mass, and the product of bone length and body mass) are compared in two modern human populations with very different body proportions: Pecos Pueblo Amerindians and East Africans. All five major long bones (excluding the fibula) were examined. Mechanical predictions are that cortical area (axial strength) should scale with body mass, while section modulus (bending/torsional strength) should scale with the product of body mass and moment arm length. These predictions are borne out for section moduli, when moment arm length is taken to be proportional to bone length, except in the proximal femoral diaphysis, where moment arm length is proportional to mediolateral body breadth (as would be expected given the predominance of M-L bending loads in this region). Mechanical scaling of long bone bending/torsional strength is similar in the upper and lower limbs despite the fact that the upper limb is not weight-bearing. Results for cortical area are more variable, possibly due to a less direct dependence on mechanical factors. Use of unadjusted bone length alone as a "size" measure produces misleading results when body shape varies significantly, as is the case between many modern and fossil hominid samples. In such cases a correction factor for body shape should be incorporated into any "size" standardization.

Disuse bone loss in hindquarter suspended rats: partial weightbearing, exercise and ibandronate treatment as countermeasures.

The purpose of this study was to evaluate potential countermeasures for bone loss during long-term space missions in the hindquarter suspended rat, including partial weight bearing (surrogate for artificial gravity) episodic full weight bearing (2 hour/day full weight bearing) and treatment with the third generation bisphosphonate ibandronate (Roche). Graded mechanical loading was studied by housing the animals on a novel servo controlled force plate system which permitted the titration of mechanical force at varying frequency and amplitude and different levels of weight bearing. The force plate, which forms the cage floor, is a glass platform supported by an 18" diameter speaker cone filled with expanding polyurethane foam. An infrared optical sensor attached to the speaker cone yields a voltage linearly related to vertical displacement of the glass platform. The dynamic force on the paw was computed as a product of the apparent mass of the animal on the platform at rest and the acceleration of the platform determined from the second derivative of the optical sensor output. The mass of the animal on the platform was varied by adjusting tension on the tether suspending the animal. Mechanical impact loading was titrated with the force plate resonating at different frequencies, including 3 Hz and 16 Hz.

The anomalous archaic Homo femur from Berg Aukas, Namibia: a biomechanical assessment.

The probably Middle Pleistocene human femur from Berg Aukas, Namibia, when oriented anatomically and analyzed biomechanically, presents an unusual combination of morphological features compared to other Pleistocene Homo femora. Its midshaft diaphyseal shape is similar to most other archaic Homo, but its subtrochanteric shape aligns it most closely with earlier equatorial Homo femora. It has an unusually low neck shaft angle. Its relative femoral head size is matched only by Neandertals with stocky hyperarctic body proportions. Its diaphyseal robusticity is modest for a Neandertal, but reasonable compared to equatorial archaic Homo femora. Its gluteal tuberosity is relatively small. Given its derivation from a warm climatic region, it is best interpreted as having had relatively linear body proportions (affecting proximal diaphyseal proportions, shaft robusticity, and gluteal tuberosity size) combined with an elevated level of lower limb loading during development (affecting femoral head size and neck shaft angle).

Cross-sectional morphology of the SK 82 and 97 proximal femora.

Computed tomography scans of the proximal femoral shaft of the South African "robust" australopithecine, A. robustus, reveal a total morphological pattern that is similar to the specimen attributed to A. boisei in East Africa but unlike that of Homo erectus or modern human femora. Like femora attributed to H. erectus, SK 82 and 97 have very thick cortices, although they do not have the extreme increase in mediolateral buttressing that is so characteristic of H. erectus. And unlike H. erectus or modern humans, their femoral heads are very small relative to shaft strength. These features are consistent with both increased overall mechanical loading of the postcranial skeleton and a possibly slightly altered pattern of bipedal gait relative to that of H. erectus and modern humans.

Diaphyseal cross-sectional geometry of the Boxgrove 1 Middle Pleistocene human tibia.

Cross-sectional geometric analysis of the early Middle Pleistocene human tibia from Boxgrove, West Sussex, U.K. reveals a mosaic pattern relative to other archaic Homo tibiae. The specimen has relatively low percent cortical area within its cross sections. However, it exhibits the high mediolateral strength characteristic of archaic Homo tibiae. Scaled solely to tibial length it is robust, similar to those of the Neandertals and above those of early modern and pre-Late Pleistocene African and Asian humans. However, given ecogeographically-patterned variance in relative tibial length and body laterality, it is most likely that it exhibits a level of robusticity within the range encompassed by Late Pliocene to Late Pleistocene archaic Homo combined with arctic body proportions. Given its association with late interglacial cool temperate climatic indicators, the inferred body proportions of the Boxgrove hominid were probably promoted by their minimal level of cultural buffering, requiring a significant biological conservation of body heat.

Experimental testing of a DEXA-derived curved beam model of the proximal femur.

This study was designed to test whether, using curved beam theory, a structural model of the proximal femur derived from two-dimensional dual energy x-ray absorptiometry could be used to predict femoral strength in an experimental simulation of a fall on the greater trochanter. A set of 22 fresh cadaveric femoral specimens were scanned with use of two-dimensional dual energy x-ray absorptiometry and then were tested to failure in a materials testing system, under three-point loading, with the ground impact vector aligned within the plane and along the bisector of the femoral neck-shaft angle. Failure locations generally corresponded to stress peak locations predicted by the curved beam model. Predicted failure loads correlated well with measured failure loads for femoral neck fractures (r=0.89; percent SE of estimate=23%) and some-what less well for intertrochanteric fractures (r=0.83; percent SE of estimate=29%). Overall predictions for failure load calculated from the maximum stress peak value over both locations corresponded to measured failure loads with an r value of 0.91 (percent SE of estimate=21%). This kind of structural approach to the analysis of data for hip bone mass has the potential to provide mechanistic interpretations of the statistical associations frequently shown between conventional bone mineral measures and either hip fracture risk in vivo or bone strength in vitro.

Locomotion and body proportions of the Saint-Césaire 1 Châtelperronian Neandertal.

The initial Upper Paleolithic (Châtelperronian) of western Europe was associated with late European Neandertals, best known through the Saint-Césaire 1 partial skeleton. Biomechanical cross-sectional analysis of the Saint-Césaire 1 femoral diaphysis at the subtrochanteric and midshaft levels, given the plasticity of mammalian diaphyseal cortical bone, provides insights into the habitual levels and patterns of loading on the lower limbs from body mass, proportions, and locomotion. The overall robustnesses of the femoral diaphyses of European Neandertals and early modern humans are similar once contrasts in body proportions are incorporated into the body size scaling. Saint-Césaire 1 matches these samples only if it is provided with Neandertal-like hyperarctic body proportions. And the rounded proximal femoral diaphysis of Saint-Césaire 1 is similar to those of earlier Neandertals, likely also reflecting similar cold-adapted broad pelvic regions. However, although morphologically similar to those of archaic Homo, the Saint-Césaire 1 femoral midshaft exhibits the anteroposterior reinforcement characteristic of early modern humans. Consequently, Saint-Césaire 1 appears as a morphological Neandertal with hyperarctic body proportions who nonetheless had shifted locomotor patterns to more closely resemble those of other Upper Paleolithic humans.

Body mass and encephalization in Pleistocene Homo.

Many dramatic changes in morphology within the genus Homo have occurred over the past 2 million years or more, including large increases in absolute brain size and decreases in postcanine dental size and skeletal robusticity. Body mass, as the 'size' variable against which other morphological features are usually judged, has been important for assessing these changes. Yet past body mass estimates for Pleistocene Homo have varied greatly, sometimes by as much as 50% for the same individuals. Here we show that two independent methods of body-mass estimation yield concordant results when applied to Pleistocene Homo specimens. On the basis of an analysis of 163 individuals, body mass in Pleistocene Homo averaged significantly (about 10%) larger than a representative sample of living humans. Relative to body mass, brain mass in late archaic H. sapiens (Neanderthals) was slightly smaller than in early 'anatomically modern' humans, but the major increase in encephalization within Homo occurred earlier during the Middle Pleistocene (600-150 thousand years before present (kyr BP)), preceded by a long period of stasis extending through the Early Pleistocene (1,800 kyr BP).

Curved beam model of the proximal femur for estimating stress using dual-energy X-ray absorptiometry derived structural geometry.

The investigation of individual differences in hip strength requires a method to measure structural geometry in vivo and a valid analytical approach to calculate mechanical stress. We developed a method for deriving structural geometry of the femur from the proximal shaft through the femoral neck, using data from dual energy X-ray absorptiometry. The geometric properties are employed in a two-dimensional curved beam model of the proximal femur to estimate stresses on the lateral and medial bone surfaces. Stresses calculated by this method are compared with those from the conventional flexure formula and with results produced from a cadaver femur with use of three-dimensional finite element analysis of computed tomography data. Loading conditions simulating a one-legged stance and a fall on the greater trochanter are employed. Stresses calculated by curved beam theory are in much better agreement with three-dimensional finite element analysis than are those for which the conventional straight beam formula was used. In simulation of a fall on the greater trochanter, all three methods show peaks of stress at the femoral neck but only the curved beam and finite element analysis methods show an additional peak at the medial intertrochanteric margin. Both neck and trochanter regions correspond to common failure sites for hip fractures in the elderly. The curved beam treatment of hip structure derived from dual-energy X-ray absorptiometry provides an approach for the in vivo engineering analysis of hip structure that is not practical by other methods.

Dual-energy X-ray absorptiometry derived structural geometry for stress fracture prediction in male U.S. Marine Corps recruits.

A total of 626 U.S. male Marine Corps recruits underwent anthropometric measurements and dual-energy X-ray absorptiometry (DXA) scans of the femoral midshaft and the distal third of the tibia prior to a 12 week physical training program. Conventionally obtained frontal plane DXA scan data were used to measure the bone mineral density (BMD) as well as to derive the cross-sectional area, moment of inertia, section modulus, and bone width in the femur, tibia, and fibula. During training, 23 recruits (3.7%) presented with a total of 27 radiologically confirmed stress fractures in various locations in the lower extremity. After excluding 16 cases of shin splints, periostitis, and other stress reactions that did not meet fracture definition criteria, we compared anthropometric and bone structural geometry measurements between fracture cases and the remaining 587 normals. There was no significant difference in age (p = 0.8), femur length (p = 0.2), pelvic width (p = 0.08), and knee width at the femoral condyles (p = 0.06), but fracture cases were shorter (p = 0.01), lighter (p = 0.0006), and smaller in most anthropometric girth dimensions (p < 0.04). Fracture case bone cross-sectional areas (p < 0.001), moments of inertia (p < 0.001), section moduli (p < 0.001), and widths (p < 0.001) as well as BMD (p < 0.03) were significantly smaller in the tibia and femur. After correcting for body weight differences, the tibia cross-sectional area (p = 0.03), section modulus (p = 0.05), and width (p = 0.03) remained significantly smaller in fracture subjects. We conclude that both small body weight and small diaphyseal dimensions relative to body weight are factors predisposing to the development of stress fractures in this population. These results suggest that bone structural geometry measurements derived from DXA data may provide a simple noninvasive methodology for assessing the risk of stress fracture.